Data related to medication order and the use of medications was collected from 94 elderly medical records of two nursing homes of Aracaju (SE), The mean age was 83.2 (SD = 10.1), with most belonging to the females (63.8%). The prevalence of the use of drugs was 87.2% and the average of medicines consumed was equal to 2.7 (SD = 1.8), mainly with action in the cardiovascular and nervous systems. In this Study, the elderly population studied presented polypharmacy (18.1%), inappropriate use of drugs (28.7%) and double therapy (11.7%). Data showed the need for improvement and evaluation of the quality of pharmacotherapy to promote rational drug use in the elderly population.

Objective: The primary objective of this study was to evaluate the effect of a pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. The clinical outcomes of this pharmacotherapy adherence approach were the secondary objective of the study. Setting: Public Primary Health Care Unit in a municipality in the Brazilian State of Sao Paulo. Method: A 36-month randomized, controlled, prospective clinical trial was carried out with 200 patients divided into two groups: control (n = 100) and intervention (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultancies). The patients randomized into the intervention group received pharmaceutical care intervention besides the usual care offered. Main outcome measure: Pharmacotherapy adherence (Morisky-Green test translated into Portuguese and computerized dispensed medication history) and clinical measurements (blood pressure, fasting glucose, A1C hemoglobin, triglycerides and total cholesterol) were evaluated at the baseline and up to 36 months. A P value < 0.05 was considered statistically significant. Results: A total of 97 patients from the intervention group and 97 patients from the control group completed the study (n = 194). Significant improvements in the pharmacotherapy adherence were verified for the intervention group according to the Morisky-Green test (50.5% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001) and the computerized dispensed medication history (52.6% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001); no significant changes were verified in the control group. Significant improvements in the number of patients reaching adequate values for their blood pressure (26.8% at baseline vs. 86.6% after 36-months; P < 0.001)...

Objectives: To identify the prevalence of neuropsychiatric disorders, especially DP and CD, on a sample of nursing home residents, relating this prevalence with some aspects of the demographics and psycho pharmacotherapy. Methods: 48 elders from two different nursing homes were selected. The collection of demographic and pharmacological data was made utilizing medical records. The medication was classified according to the Anatomical Therapeutic Chemical Code (ATC) criteria. The Geriatric Depression Scale (GDS 30) and the Mini Mental State Examination (MMSE) tests were utilized to determine the prevalence of DP and CD. Results: It was observed in the sample a high incidence of DP and CD among the researched elders. More schooling individuals tend to present less CD. Individuals with less CD indicatives present less symptomatology for DP. Of all the researched elders, 54,2% are submitted to psycho pharmacotherapy. Of all the consumed medicine, 16,5% belonged to the class of neuropsychiatric medicine. The medicated elders present, in average, a larger symptomatology for DP (12 points/average/GDS) than the non-medicated elders (9,9 points/average/GDS). The inverse occurs in relation to the CD indicatives. The use of psychotropics, especially in association...

The incorporation of real problems into health education is seen as an effort to prepare future health professionals to meet the challenging demands of the profession, in particular, the provision of quality patient care. The foundation of this methodology can be traced back to Dewey. The author suggested that students should be presented with real life problems in order to discover the information required to solve them. With the introduction of the Bologna Process in Portugal, the School of Allied Health Sciences of Oporto, saw this opportunity to put in practice Dewey´s axiom. This paper represents a small part in the process of integrating a Case Based, Learner Centered approach to Pharmacotherapy. Since 2008, Pharmacotherapy is no longer taught in a lecture based model. With the implementation of Bologna Process in the Pharmacy Degree, some basic science curricular units maintained their lecture based approach, only to serve as mediators to a more student-centered approach in the applications of knowledge to real life situations. Pharmacology and Pharmacotherapy,are good examples of this dichotomy. Normally the students have to attend lectures on pharmacology topics during one week, then in the next week, they will have to collaborative solve a real problem (relating to the previous week Pharmacology topics) during a pre-established time...

Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson’s disease patients’ results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient’s case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services.

Panic disorder (PD) is a common, persistent and disabling mental disorder. It is often associated with agoraphobia. The present article reviews the current status of pharmacotherapy for PD with or without agoraphobia as well as the current status of treatments combing pharmacotherapy with cognitive behavior therapy (CBT). The review has been written with a focus on randomized controlled trials, meta-analyses, and reviews that have been published over the past few years. Effective pharmacological treatments include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and various benzodiazepines. Treatment results obtained with CBT compare well with pharmacotherapy, with evidence that CBT is at least as effective as pharmacotherapy. Combining pharmacotherapy with CBT has been found to be superior to antidepressant pharmacotherapy or CBT alone, but only in the acute-phase treatment. Long term studies on treatments combining pharmacotherapy and CBT for PD with or without agoraphobia have found little benefit, however, for combination therapies versus monotherapies. New investigations explore the potential additional value of sequential versus concomitant treatments...

Background New drugs and new formulations enter the growing market for ADHD medication. The growing awareness of possible persistence of ADHD impairment beyond childhood and adolescence resulting in increased pharmacotherapy of ADHD in adults, is also a good reason for making an inventory of the what is generally known about pharmacotherapy in ADHD. Aim To discuss current issues in the possible pharmacotherapy treatment of ADHD in children, adolescents and adults with respect to the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used. Methods A search of the literature with an emphasis on the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used in pharmacotherapy. Results According to the guidelines, the treatment of ADHD in children consists of psychosocial interventions in combination with pharmacotherapy when needed. Stimulants are the first-choice drugs in the pharmacological treatment of ADHD in children despite a number of well known and frequently reported side effects like sleep disorders and loss of appetite. With regard to the treatment of adults, stimulant treatment was recommended as the first-choice pharmacotherapy in the single guideline available. Both in children and adults...

Chronic noncancer pain is a significant and growing public health challenge in the United States. Lacking effective alternative interventions for effective chronic noncancer pain management, many physicians have turned to opioid pharmacotherapy. Increased opioid prescribing brings not only gains in therapeutic benefit but also a higher incidence of adverse drug events including increased medication misuse and opioid related mortality. Currently the United States must confront the dual problems of widespread undertreated chronic noncancer pain and a prescription opioid abuse crisis. Withholding pain relieving drugs from patients in need is unjustifiable, yet drug diversion, abuse and adverse drug events have become major social as well as medical problems. At the heart of this crisis is the lack of definitive evidence about the risk to benefit ratio of opioid pharmacotherapy for chronic noncancer pain both on an individual case and on a population basis. This article describes the extent and severity of the American chronic noncancer pain problem and the history of opioid pharmacotherapy for chronic noncancer pain in the United States. It then discusses the concept of evidence based practice and reviews current evidence supporting opioid pharmacotherapy for chronic noncancer pain as well as adverse drug events related to opioid pharmacotherapy including misuse and abuse. Finally...

This study evaluated available controlled treatment studies to determine utility of pharmacotherapy for binge-eating disorder (BED). The authors identified randomized placebo-controlled trials testing pharmacotherapy-only treatments and controlled trials testing pharmacotherapy with psychotherapy treatments. Meta-analysis was performed on placebo-controlled trials with data for attrition, remission, and weight loss. Qualitative review was performed on remaining controlled treatment literature. A total of 33 studies were considered of which 14 studies with a total of 1,279 patients were included in the meta-analysis of pharmacotherapy-only treatment and 8 studies with a total of 683 patients were included in the qualitative review of pharmacotherapy combined with psychotherapy interventions. No evidence suggested significant differences between medication and placebo for attrition. Evidence suggested that pharmacological treatments have a clinically significant advantage over placebo for achieving short-term remission from binge eating (48.7% vs. 28.5%) and for weight loss, although weight losses are not substantial. No data exist to allow evaluation of longer-term effects of pharmacotherapy-only treatment for BED. Combining medications with psychotherapy interventions failed to significantly enhance binge outcomes...

Although psychotherapy and antidepressant medication are efficacious in the treatment of depressive and anxiety disorders, it is not known whether they are equally efficacious for all types of disorders, and whether all types of psychotherapy and antidepressants are equally efficacious for each disorder. We conducted a meta-analysis of studies in which psychotherapy and antidepressant medication were directly compared in the treatment of depressive and anxiety disorders. Systematic searches in bibliographical databases resulted in 67 randomized trials, including 5,993 patients that met inclusion criteria, 40 studies focusing on depressive disorders and 27 focusing on anxiety disorders. The overall effect size indicating the difference between psychotherapy and pharmacotherapy after treatment in all disorders was g=0.02 (95% CI: −0.07 to 0.10), which was not statistically significant. Pharmacotherapy was significantly more efficacious than psychotherapy in dysthymia (g=0.30), and psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with tricyclic antidepressants (g=0.21). These results remained significant when we controlled for other characteristics of the studies in multivariate meta-regression analysis...

Substance use disorders are highly prevalent, debilitating conditions for which effective pharmacotherapies exist with a broad evidence base, yet pharmacotherapy for the treatment of addiction disorders is underutilized. The goals of this review are to describe the barriers that may contribute to poor adoption and utilization of pharmacotherapy for alcohol and opioid dependence at the system, provider, and patient level and to discuss ways to overcome those barriers. Multifaceted efforts directed at all three levels may be needed to speed pharmacotherapy adoption. More research is needed to help us better understand barriers from patients’ perspectives. Strategies to promote adoption of pharmacotherapy for addiction disorders should be modified to fit the needs of the practice, system, and individual patients. Pharmacotherapy is a valuable tool in the clinical armamentarium of addiction treatment; thus, overcoming barriers to implementation may improve clinical and social outcomes.

Abstract Methamphetamine dependence is a serious public health problem worldwide for which there are no approved pharmacological treatments. Psychotherapy is still the mainstay of treatment; however, relapse rates are high. The search for effective pharmacological treatment has intensified in the last decade. This review will highlight progress in pharmacological interventions to treat methamphetamine dependence as well as explore new pharmacological targets. Published data from clinical trials for stimulant addiction were searched using PubMed and summarized, as well as highlights from a recent symposium on methamphetamine pharmacotherapy presented at the ISAM 2006 meeting, including interim analysis data from an ongoing D-amphetamine study in Australia. Early pilot data are encouraging for administering D-amphetamine and methylphenidate as treatment for heavy amphetamine users. Abilify at 15 mg/day dose increased amphetamine use in an outpatient pilot study. Sertraline, ondansetron, baclofen, tyrosine, and imipramine were ineffective in proof-of-concept studies. Development of pharmacotherapy for methamphetamine dependence is still in an early stage. Data suggesting D-amphetamine and methylphenidate as effective pharmacotherapy for methamphetamine addiction will need to be confirmed by larger trials. Preclinical data suggest that use of GVG...

Despite the prevalence of psychiatric co-morbidity in chronic hepatitis C (CHC), treatment is under-researched. Patient preferences are likely to affect treatment uptake, adherence, and success. Thus, the acceptability of psychological supports was explored. A postal survey of Australian CHC outpatients of the Royal Adelaide Hospital and online survey of Australians living with CHC was conducted, assessing demographic and disease-related variables, psychosocial characteristics, past experience with psychological support, and psychological support acceptability. The final sample of 156 patients (58 % male) had significantly worse depression, anxiety, stress, and social support than norms. The most acceptable support type was individual psychotherapy (83 %), followed by bibliotherapy (61 %), pharmacotherapy (56 %), online therapy (45 %), and group psychotherapy (37 %). The most prominent predictor of support acceptability was satisfaction with past use. While individual psychotherapy acceptability was encouragingly high, potentially less costly modalities including group psychotherapy or online therapy may be hampered by low acceptability, the reasons for which need to be further explored.; Benjamin J. R. Stewart, Deborah Turnbull, Antonina A. Mikocka-Walus...

The cross-cultural translation from spanish to portuguese (european) of the Second Consensus of Granada on Pharmacotherapy failure has the objective to provide clinicians and researchers, working in drug therapy follow-up, with a working tool translated with the accuracy and the reliability that a biomedical document requires. The common origin of the spanish and portuguese languages emphasizes the need to do a cross-cultural translation. Errors of translation or wrong interpretations can be due to falses cognates. The cross-cultural translation followed three steps: translation, back-translation and review of the translation of the original text of the Second Consensus of Granada on Pharmacotherapy failure. The result was the portuguese version of the Second Consensus of Granada on Pharmacotherapy failure, presented in the annex I.; The cross-cultural translation from spanish to portuguese (european) of the Second Consensus of Granada on Pharmacotherapy failure has the objective to provide clinicians and researchers, working in drug therapy follow-up, with a working tool translated with the accuracy and the reliability that a biomedical document requires. The common origin of the spanish and portuguese languages emphasizes the need to do a cross-cultural translation. Errors of translation or wrong interpretations can be due to falses cognates. The cross-cultural translation followed three steps: translation...

Introduction: Chemotherapy-induced alimentary mucositis is an extremely common condition that is caused by a breakdown of the mucosal barrier. It occurs in between 40 - 100% of cancer patients depending on the treatment regimen. Symptoms typically include pain from oral ulceration, vomiting and diarrhoea. Alimentary mucositis often necessitates chemotherapy reductions or treatment breaks, overall potentially compromising survival outcomes. Consequently, alimentary mucositis creates a burden not only on patients' quality of life but also on healthcare costs. Despite this, currently, there is no clinically effective localised/pharmacological therapy intervention strategy to prevent alimentary mucositis. Areas Covered: Over recent years, a number of novel pharmacotherapy agents have been trialed in various preclinical and clinical settings. This critical review will therefore provide an overview of emerging pharmacotherapies for the treatment of alimentary mucositis following chemotherapy with particular emphasis on studies published in the last 2 years. A Pubmed literature search was conducted to identify eligible articles published before 30 November 2013 and each article was reviewed by all authors. All articles were written in English. Expert Opinion: Currently...

peer-reviewed; Objectives
To estimate the effect of pharmacotherapy on PTSD, anxiety, and
depression among combat veterans; to determine whether the effects
varied according to patient and intervention characteristics; and to
examine differential effects of pharmacotherapy on outcomes.
Materials and Methods
Google Scholar, PILOTS, PsycINFO, PubMed, and Web of Science
databases were searched through November 2014. Searches resulted in
eighteen double-blind, placebo controlled trials of 773 combat veterans
diagnosed with PTSD and included only validated pre-
and post-intervention PTSD and anxiety or depression measures. Authors
extracted data on effect sizes, moderators, and study quality. Hedges'
d effect sizes were computed and random effects models
estimated sampling error and population variance. The Johnson-Neyman
procedure identified the critical points in significant interactions to
define regions of significance.
Results
Pharmacotherapy significantly reduced (∆,95%CI) PTSD (0.38,
0.23-0.52), anxiety (0.42, 0.30-0.54), and depressive symptoms (0.52,
0.35-0.70). The effect of SSRIs and tricyclic antidepressants on PTSD
were greater than other medications independent of treatment
duration. The effect of SSRIs and tricyclic antidepressants were
greater than other medications up to 5.2 and 13.6 weeks for anxiety and
depression...

Treatment non-adherence in psycho-pharmacotherapy remains a significant challenge to the effective clinical management of psychiatric disorders, especially among underserved racial/ethnic groups. This article introduces Motivational Pharmacotherapy, an approach that integrates Motivational Interviewing into psycho-pharmacotherapy sessions in order to increase treatment adherence. We describe what aspects of Motivational Interviewing were incorporated into Motivational Pharmacotherapy and how we tailored the intervention to the clinical and cultural characteristics of monolingual Spanish-speaking immigrants with Major Depressive Disorder. Transcriptions of the interactions between psychiatrists and patients help illustrate this approach. In our experience, Motivational Pharmacotherapy differs substantially from standard pharmacotherapy in how it recasts clinicians and patients as equal experts, prioritizes patients' motivation to engage in treatment rather than clinicians' multiple inquiries about symptoms, encourages patients' self-efficacy to overcome barriers, and attends to the momentum of patients' language about commitment to change. We also found that Motivational Pharmacotherapy can be feasibly incorporated into medication treatment...

Since variations on the renin angiotensin (RA) system tend to exert effects on blood pressure, we investigated the association of the common ACE and AT1R polymorphisms with response to a multivariate pharmacotherapy. Methods: This prospective study involved 169 hypertensive, community-dwelling older women. Genotypes were obtained by length analysis or direct sequencing of PCR products. Blood pressure-lowering pharmacotherapy was conducted according to current Brazilian Guidelines on Hypertension. Results: Genotype frequencies were in agreement to the Hardy–Weinberg equilibrium. Interventions were found to represent actual hypertension-management practices in Brazil, and accounted for a significant reduction in both systolic (Pb0.001) and diastolic (Pb0.001) blood pressure. Concerning the effect of polymorphisms, no influence of the ACE and AT1R genotypes were found on the magnitude of the treatmentinduced blood pressure reduction (PN0.05). Nonetheless, the clinical result varied according to the ACE alleles since mean systolic pressure was roughly 10 mm Hg higher in insertion (I) homozygotes than in the deletion (D) counterparts either in baseline (P=0.001) and endpoint (P=0.010). Conclusion: The outcome of the antihypertensive pharmacotherapy advocated by national guidelines was significantly influenced by the ACE I/D polymorphism but not by the AT1R 1166 A/C polymorphism among postmenopausal women.

Objective: All currently available definitions of health literacy may be considered quite general. Given the complex nature of the patient-pharmacy encounter and the varying tasks required to properly and successfully consume or administer medication or to adhere to a pharmaceutical care regimen, these available definitions may describe inadequately a patient's health literacy for the purpose of pharmacotherapy and pharmacist intervention. Therefore, the objective of this research was to conceptualize the Pharmacotherapy Literacy construct. Methods: Licensed pharmacists (n=2,368) were mailed a questionnaire providing them with the Healthy People 2010 definition of health literacy and asked, "Given this definition, how would you define Pharmacotherapy Literacy?" A total of 420 usable surveys were returned of which 176 (42%) included responses to the open-ended question concerning pharmacotherapy literacy. Responses were reviewed independently and collectively by the authors. Common themes were identified, compared and discussed until consensus was reached. An initial definition was formulated and distributed to six doctoral-trained academicians and practicing pharmacists who were asked to offer their opinions of the definition as well as suggestions for its improvement. The definition was modified and subjected to further review from 15 additional doctoral-trained academicians and practicing pharmacists who provided feedback concerning its improvement. Results: Based on the recommendations received from the academicians and pharmacists...